Pain Management Coding Alert

Question:  Our physician inserted a spinal epidural catheter to break spinal adhesions and left the catheter in place to continue treatment over the next four days. How can we report this extended service over four days?

Wisconsin Subscriber

Answer:  You report code 62263 (Percutaneous lysis of epidural adhesions using solution injection [e.g., hypertonic saline, enzyme] or mechanical means [e.g., catheter] including radiologic localization [includes contrast when administered], multiple adhesiolysis sessions; 2 or more days) for this procedure of epidural adhesiolysis.

Report only once: You report code 62263 only once regardless of the number of days in total. You hence will not submit four units of 62263. The descriptor of code 62263 clearly specifies “2 or more days.”

One day has specific code: If your surgeon did the procedure over only one day, you would submit code 62264 (Percutaneous lysis of epidural adhesions using solution injection [e.g., hypertonic saline, enzyme] or mechanical means [e.g., catheter] including radiologic localization [includes contrast when administered], multiple adhesiolysis sessions; 1 day).

Do not count adhesions: You count the days and not the adhesions. Codes 62263 and 62264 are reported to describe the entire series of injections/infusions spanning the total number of treatment days.

Tip: Do not report 62263 and 62264 together. Remember that codes 62263 and 62264 are mutually exclusive, so you should report only one of these codes. You will also report a maximum of one unit of service for the epidural lysis of adhesion code.

Fluoroscopy is inclusive in 62263 and 62264: When reporting, 62263 or 62264, you do not separately bill for fluoroscopy or epidurography. CPT^® describes these procedures as integral to codes 62263 and 62264. You would not report 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural or subarachnoid]) or 72275 (Epidurography, radiological supervision and interpretation) with codes 62263 or 62264.